影响都江堰市犬伤门诊分级诊疗现状的原因分析  

Analysis of the Influencing Factors for Tiered Medical Service in Dog-bite Clinic of Dujiangyan City

作　　者：杨鼎君[1,2] 曹钰[1] 付乐章[2] 杨晓燕[2] 

机构地区：[1]四川大学华西临床医学院/华西医院急诊科,成都610041 [2]都江堰市人民医院急诊科

出　　处：《华西医学》2016年第12期2013-2016,共4页West China Medical Journal

摘　　要：目的探索影响都江堰市综合性医院与乡镇(社区)卫生院犬伤门诊就诊情况的原因,为犬伤的规范化诊疗提供参考依据。方法采取回顾性观察研究的方法,通过调取都江堰市疾病预防控制中心数据库,收集2012年1月-2015年12月期间都江堰市行政区域内所有设有犬伤门诊的医疗机构每年收治的犬伤患者资料。并于2016年3月采用调查问卷的方式,收集两种级别医疗机构犬伤患者的就诊满意度以及犬伤门诊工作人员对犬伤暴露伤口处置方法的知晓率。比较上述指标间的差异,寻找可能影响都江堰市犬伤门诊分级诊疗的原因。结果全市共有1家综合性医院和27家乡镇(社区)卫生院设有犬伤门诊并全部参与此次研究。研究期间,综合性医院每年收治的犬伤患者总数量及其占全年所有犬伤患者的比例逐年递减,尤其Ⅱ级犬伤暴露患者数量明显减少。而乡镇(社区)卫生院收治犬伤患者的总数量及其占全市所有犬伤患者的比例则呈逐年递增趋势,其中Ⅱ级和Ⅲ级犬伤暴露患者的数量于2015年达峰值,分别为1 944例(44.10%)和1 248例(28.31%)。满意度和知晓率调查结果提示,综合性医院的该两项指标均均高于乡镇(社区)卫生院,两者之间差异有统计学意义(P<0.05)。结论都江堰市综合性医院和乡镇(社区)卫生院犬伤门诊患者就诊总量变化基本符合分级诊疗要求,但后者需进一步加强犬伤门诊工作人员的培训,规范犬伤处置流程,最终提高患者就诊满意度。ObjectiveTo explore the possible factors which can influence the tiered medication situation in dog-bite clinic in comprehensive hospitals and village （community） health service centers, in order to provide references for the standardization of the diagnosis and treatment for dog-bite exposed patients. MethodsWe conducted a retrospective observational study, searched the database of Dujiangyan Center for Disease Control and Prevention, and collected all the information of dog-bite patients administrated by village （community） health service center or hospital from January 2012 to December 2015.Then we investigated the patients＇ satisfaction and clinical workers＇ familiarity of dog-bite injury treatment protocols by questionnaires in March 2016.The data were analyzed with statistical description and chi-square test, to explore the possible factors which might influence the tiered medication situation for patients exposed to dog bite in Dujiangyan city. ResultsThere was one comprehensive hospital and 27 township （community） health centers included in this study.During the study period, the total number and proportion of dog-bite injury patients admitted in the comprehensive hospital decreased year by year, especially for the number of grade-two dog-bite exposure patients.One the contrary, the total number and proportion of patients administrated by township （community） health service centers increased year by year, especially for the number （proportion） of grade-two and grade-three dog-bite exposure patients, which increased to 1 944（44.10%） and 1 248（28.31%）, respectively.The results also showed that there were significant differences between the comprehensive hospital and township health centers in the satisfaction and familiarity investigation （P 〈 0.05）. ConclusionsTownship and village （community） health service centers are treating many more patients than the comprehensive hospital, but with a lower satisfaction rate.The distribution of dog-bite exposure patients visit

关 键 词：犬伤门诊 分级诊疗 综合医院 

分 类 号：R512.99[医药卫生—内科学]